MEDICARE: GLENN M MADRID MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DR.0028519	CO

General Provider Information

NPI Number	:	1982687620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN M MADRID MD

Provider Business Mailing Address
First Line	:	3835 HORIZON GLEN CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-5425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 HORIZON GLEN CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-5425
Country	:	US
Telephone Number	:	970-241-6011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/06/2025

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